Employer Healthcare Challenges and the Role of the Employee-Patient in Healthcare Benefit Design: An expert advisory panel

Hosted by: National Psoriasis Foundation
Faegre BD Consulting | 1050 K Street NW | Suite 400 | Washington, DC 20001
Wednesday, February 22, 2017 | 10:00 a.m. – 2 p.m.

Overview

In the last 20 years, health care delivery, the pace of research, and insurance systems and processes in the United States have all dramatically changed, – predominantly in the development of innovative new treatments and sizeable changes to the insurance and payment systems. These changes have produced more treatment options and have expanded access to care and improved lives. However, they have also triggered concerns, particularly for employers, as they address increasing medical costs. The National Psoriasis Foundation (NPF) seeks to open a dialogue with employers regarding the management of these costs – focused specifically around psoriatic disease management and treatment, particularly the healthcare and economic benefits of early intervention and proactive disease management using targeted therapies.

NPF has recognized that employers play a major and important role in the care of employees and dependents living with psoriatic disease. Psoriasis costs the U.S. $135 billion annually. Direct costs for patients can be upwards of $8,000 per year. Indirect costs, which take into account absences from work, or lost productivity on the job due to psoriasis, were estimated to be upwards of $4,000 per person annually—or as much as $35.4 billion for the United States. In 2016, the NPF convened an insurer roundtable in order to begin a dialogue regarding what actions among patients, providers, and health insurance companies are needed to help inform and influence treatment and payer decision-making. NPF believes an expansion of this dialogue with input from employers, many of whom are sponsors of self-funded health plans, will be beneficial to all parties interested in the effective and efficient treatment of this disease.

On February 22, NPF will host an Employer Roundtable with interested employer benefits representatives in order to discuss the treatment regimen for psoriatic disease, explore the costs of treatment on a continuum of disease management, and identify how NPF can work more closely with employers to address their questions regarding cost and treatment of those personally affected by psoriatic disease.

Goals & Objectives

  • Establish a dialogue between the leading psoriatic disease community organization and employers, and/or employer organizations, with a focus on ensuring patients with psoriatic disease have access to recommended treatments.
  • Assist NPF in understanding the concerns employers have when making healthcare benefits decisions.
  • Update employers on the December 2016 ICER (Institute for Clinical and Economic Review) final report, which illustrates that treating individuals living with psoriasis with targeted immunomodulators is appropriate and recommends that health insurers limit or abolish step therapy for such patients and therapies.
  • Identify resources employers and/or employer organizations would find of value when considering coverage decisions for individuals with psoriatic disease and others living with complex chronic conditions. (Based on this input, resources will be developed and disseminated following meeting).

Roundtable Agenda

10:00 – 10:15 Welcome and introductions
10:15 – 10:45 Individuals with Chronic Disease in the Workforce: Overview of psoriatic disease, including a natural history of the disease, prevalence, age of onset and other statistics, current treatment options and standard of care, and clinical opportunities and challenges. 
10:45 – 11:00 The Patient Perspective: Three patients with psoriatic disease will speak about the disease, how it has affected their lives, their clinical experiences, and their experiences accessing clinically recommended care. 
11:00 – 11:20 ICER Psoriasis Review: presented by Sarah Emond, ICER COO Overview of 2016 Institute for Clinical and Economic Review assessment of psoriasis therapies and policy findings related to access to care.
11:20 – 12:00 Employer Perspectives: Attendees will speak about considerations when making benefit design decisions for their employees and dependents, how input from payers, brokers, employee benefits consultants, and pharmacy benefit managers impacts coverage decisions, and what types of information from patients and their medical providers shape such decisions.
12:00 – 12:10  Break
12:10 - 12:30 Working Lunch: Topic Overviews:  NPF leadership will provide a basic overview of two afternoon lunch discussions. Afternoon discussion will be an opportunity to explore challenges employers face in selecting coverage, and employee perspectives on employer provided health care.
12:30 - 1:15 Topic 1 - Balancing costs and employer out-of-pocket cost-share considerations: This session will explore more deeply the current and looming challenges employers are facing in shaping benefits plans. It will look at issues including trends in the marketplace, the impact of good vs. ill health on employee job performance, and potential novel approaches to help ensure employees with specific needs can achieve affordable access to clinically recommended care.
1:15 – 1:50 Topic 2 - Changing plans, avoiding confusing employees: NPF often hears patients whose condition is well-managed indicate that a significant fear is what could happen if their coverage were to change or if they were to lose their coverage. This session will probe this concern more fully, including decisions that influence employers to change plans, and what actions can be taken to mitigate the impact of such transitions on patients.
1:50 – 2:00 Summary, Follow-on Actions and Closing Remarks

*Travel Assistance is available for employer representatives located outside of the Washington, D.C. region.

Meeting Organizer
National Psoriasis Foundation
Leah Howard, JD
Vice President, Government Relations and Advocacy
503-546-5553
[email protected]